Attitudinal variables and a possible mediating mechanism for vaccination practice in health care workers of a local hospital in L'Aquila (Italy)

Abstract

Active immunization is an important concern for health care workers (HCWs) susceptible subjects and potential sources of infection for patients. However, the vaccine coverage for vaccine preventable diseases (VPDs) is below recommended standards. The aims of the study were to estimate the hospitals' HCWs' susceptibility and vaccination coverage rates for VPDs and to analyze the role of HCWs' attitudes and knowledge as determinants of the immunization practices. A cross-sectional study enrolled 334 HCWs (physicians, nurses, others) at local hospital in L'Aquila (Italy). By means of an anonymous questionnaire, self-report data about history of disease and active vaccination for seasonal influenza, chickenpox, measles-mumps-rubella and hepatitis B were collected, as well as attitudes and knowledge about vaccination in HCWs. The employees showed high levels of susceptibility and insufficient vaccination coverage rates, particularly for influenza. Specific trends were detected for different VPDs across age strata and professional categories, not always consistent with literature. Overall, the level of knowledge about recommended vaccination for HCWs was low, in all categories. The active immunization status against influenza was found the most clearly associated with difference levels in 3 psychometric variables: personal responsibility, beliefs on usefulness and beliefs on risk of vaccination. A mediation mechanism was analyzed between these constructs, and an interesting indirect effect was highlighted for beliefs that could enhance the advantage of increased responsibility for HCWs. Further effort in research is needed to evaluate the black-box of longitudinal intervention studies (education, environmental changes, policies), to improve HCWs immunization.

Knowledge, attitudes, beliefs and practices of occupational physicians towards vaccinations of health care workers: A cross sectional pilot study in North-Eastern Italy

“…While in European Countries vaccination rates of HCWs against SI remain far below the target objective of 75%, still ranging between unsatisfactory rates of 14% and 50% [ 1 , 42 , 43 ], a growing number of authorities have developed initiatives aimed to increase SIV uptake among HCWs [ 2 ]. Addressing the factors that explain insufficient adherence of HCWs to official recommendation about SIV has consequently become a growing focus of attention [ 15 , 18 , 25 , 44 - 46 ]. Sound evidences do suggest that HCWs may share with the general population significant fears of side effects, misconceptions about vaccine safety, and even poor knowledge of vaccine's benefits, ultimately leading them to lower vaccination rates [ 16 , 18 , 47 ].…”

“…However, it should be stressed that several factors not necessarily included in the knowledge and risk perception assessment contribute to building up vaccine confidence (and conversely VE) [ 63 ]: although adhesion to the official recommendations is usually characterized as weak driving factors [ 18 , 25 , 28 , 29 ], attitudes of OPh may be significantly influenced by concerns about potential legal consequences of their actual implementation. In other words, participants may have reported behaviors unrelated with actual knowledge and risk perception, exhibiting a sort of " social desirability bias ", i.e.…”

“…Collectively, aforementioned factors concur to the definition of vaccine hesitancy (VE), i.e. the continuum between full acceptance of vaccines with no doubts and the complete refusal with no doubts [ 28 - 31 ], and VE would in turn impair proactive behaviors, ultimately contributing to low vaccination rates [ 2 , 16 , 18 , 25 - 31 ].…”

“…However, vaccination coverage remains heterogeneous and usually unsatisfactory, with rates well below the minimum target of 75% required by the European Commission, as still ranging from about 15% to 50% in different countries [ 4 , 15 , 20 - 23 ]. Although Italian data on vaccination coverage among HCWs are not routinely available, recent studied have confirmed an inadequate compliance, suggesting that vaccination rates would have significantly declined since 2009 H1N1 pandemic, being presumptively well below 20% [ 7 , 12 15 , 19 , 24 , 25 ].…”

“…actual risk for HCWs) and its potential consequences, misbelieves about vaccine-related risks and vaccine safety, as well as a diffuse lack of trust in the health policies and in the health authorities that promote them [ 2 , 16 , 26 , 27 ]. In facts, a significant share of HCWs still understand SI as a mild illness not requiring a specific prophylaxis, and that contracting the disease is somehow safer than getting the vaccine [ 2 , 16 , 18 , 25 - 31 ]. Collectively, aforementioned factors concur to the definition of vaccine hesitancy (VE), i.e.…”